Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database



The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences.


Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model.


A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70 years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis.


Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversion.

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Change history

  • 04 June 2019

    In the “Results” section of the Abstract, the sentence: “The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p &lt; 0.01), the complication rate (65% vs 32.2%, p &lt; 0.01), chest tube duration (p &lt; 0.01) and the hospitalisation rate (p &lt; 0.01) were higher for patients converted.” should read: “The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p &lt; 0.01), the complication rate (65% vs 32.2%, p &lt; 0.01), chest tube duration (p &lt; 0.01) and length of stay (p &lt; 0.01) were higher for patients converted.”


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List of collaborators of the Italian VATS Group: Carlo Curcio (Monaldi Hospital, Napoli); Dario Amore (Monaldi Hospital, Napoli); Giuseppe Marulli (University of Padova); Samuele Nicotra (University of Padova); Andrea De Negri (San Martino Hospital, Genova); Paola Maineri (San Martino Hospital, Genova); Gaetano Di Rienzo (Vito Fazzi Hospital, Lecce); Camillo Lopez (Vito Fazzi Hospital, Lecce); Roberto Crisci (University Hospital L’Aquila-Teramo); Duilio Divisi (University Hospital L’Aquila-Teramo); Angelo Morelli (S. Maria delle Misericordia Hospital, Udine); Alessandro Bertani (IRCCS ISMETT-UPMC, Palermo); Emanuele Russo (IRCCS ISMETT-UPMC, Palermo); Francesco Londero (S. Maria delle Misericordia Hospital, Udine); Lorenzo Rosso (General Hospital, University of Milan, Milano); Lorenzo Spaggiari (IEO Hospital, Milano); Roberto Gasparri (IEO Hospital, Milano); Guido Baietto (Maggiore della Carita` Hospital, Novara); Caterina Casadio (Maggiore della Carita` Hospital, Novara); Maurizio Infante (Borgo Trento Hospital, Verona); Cristiano Benato (Borgo Trento Hospital, Verona); Marco Alloisio (IRCCS Humanitas, Milano); Edoardo Bottoni (IRCCS Humanitas, Milano); Andrea Droghetti (Carlo Poma Hospital, Mantova); Andrea Giovanardi (Carlo Poma Hospital, Mantova); Giuseppe Cardillo (Forlanini Hospital, Roma); Francesco Carleo (Forlanini Hospital, Roma); Luca Bertolaccini (Maggiore Teaching Hospital, Bologna); Piergiorgio Solli (Maggiore Teaching Hospital, Bologna); Franco Stella (S. Orsola Hospital, Bologna); Giampiero Dolci (S.Orsola Hospital, Bologna); Francesco Puma (University of Perugia); Damiano Vinci (University of Perugia); Giorgio Cavallesco (University of Ferrara); Pio Maniscalco (University of Ferrara); Desideria Argnani (AUSL Romagna Hospital Forli); Luca Ampollini (University of Parma); Paolo Carbognani (University of Parma); Alberto Terzi (Negrar Hospital, Verona); Andrea Viti (Negrar Hospital, Verona); Giampiero Negri (S. Raffaele Hospital, Milano); Alessandro Bandiera (S. Raffaele Hospital, Milano); Reinhold Perkmann (Bolzano Hospital, Bolzano); Francesco Zaraca (Bolzano Hospital, Bolzano); Mohsen Ibrahim (S. Andrea Hospital, Roma); Camilla Poggi (S. Andrea Hospital, Roma); Felice Mucilli (S. Maria Annunziata Hospital, Chieti); Pierpaolo Camplese (S. Maria Annunziata Hospital, Chieti); Luca Luzzi (University of Siena); Marco Ghisalberti (University of Siena); Andrea Imperatori (University of Varese); Nicola Rotolo (University of Varese); Luigi Bortolotti (Humanitas Gavazzeni Hospital, Bergamo); Giovanna Rizzardi (Humanitas Gavazzeni Hospital, Bergamo); Massimo Torre (Niguarda Hospital, Milano); Alessandro Rinaldo (Niguarda Hospital, Milano); Armando Sabbatini (Ospedali Riuniti, Ancona); Majed Refai (Ospedali Riuniti, Ancona); Mauro Roberto Benvenuti (Spedali Civili, Brescia); Diego Benetti (Spedali Civili, Brescia); Alessandro Stefani (Ospedale Policlinico, Modena); Pamela Natali (Ospedale Policlinico, Modena); Paolo Lausi (Ospedale Molinette, Torino); Francesco Guerrera (Ospedale Molinette, Torino).

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Correspondence to Stefano Bongiolatti.

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Stefano Bongiolatti, Alessandro Gonfiotti, Domenico Viggiano, Sara Borgianni, Leonardo Politi, Roberto Crisci, Carlo Curcio and Luca Voltolini have no conflicts of interest or financial ties to disclose.

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Bongiolatti, S., Gonfiotti, A., Viggiano, D. et al. Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database. Surg Endosc 33, 3953–3962 (2019). https://doi.org/10.1007/s00464-019-06682-5

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  • Video-assisted thoracic surgery
  • Lobectomy
  • Lung cancer
  • Conversion
  • Complications